Bridges to Primary Care:A Randomized Controlled Trial. Transforming Postpartum Primary Care Coordination for People with Chronic Conditions

Over 30 percent of pregnant people have at least one chronic condition, and 20 percent have prenatal conditions that increase the risk of chronic disease later in life. While patients may be highly engaged in prenatal care, they encounter a “postpartum cliff” in health system support after delivery; many receive no postpartum primary care at all despite having ongoing medical needs. Thus, the lack of coordination between obstetric and primary care represents a missed opportunity to increase primary care engagement. The objective of this study is to enhance postpartum primary care engagement, quality, and experience through the use of a behavioral economics-informed intervention. The intervention includes default PCP visit scheduling, tailored nudge messages, ongoing care recommendations sent to the PCP, and patient-facing information on the importance of primary care. Using a randomized controlled trial of 1,320 participants, the proposed study will measure the intervention’s impact on: (Aim 1) postpartum primary care visit completion, sustained engagement, and disparities in these outcomes; (Aim 2) high-value primary care service use; and (Aim 3) patient experience, stress, and mental health. By targeting a vulnerable population at a time of great need, postpartum-to-primary care coordination has the potential to catalyze sustained primary care engagement throughout life and improve long-term health.